Healthcare leaders give reform ruling mixed reviews

Some hospital groups are hailing the Supreme Court 5-4 decision to uphold the individual mandate of the Affordable Care Act, saying it will help healthcare reach the goals its struggled with for years: improving quality, reducing costs and improving access to healthcare.

But many qualified their praise, saying a Medicaid opt-out provision will be especially hard on safety-net hospitals and the at-risk populations they serve. 

Ruling reaffirms efforts already underway 
Healthcare leaders have said they would continue ahead with reform-inspired projects, such as accountable care organizations, medical home models and preventative care programs. But many agree the ruling goes a long way toward supporting those efforts and reaffirming that the healthcare industry is headed down the right path.    

In an American Hospital Association statement, AHA President and CEO Rich Umbdenstock said the decision gives hospitals "much-needed clarity to continue on their path toward transformation." 

And the Federation of American Hospitals (FAH) said the high-court ruling gives hospitals the green light to continue with initiatives set in motion when President Obama released his health plan in 2010. 

"This outcome ... sustains the ability of hospitals to continually improve healthcare quality and transform the healthcare delivery system," FAH President and CEO Chip Kahn said in a statement

The National Association of Public Hospitals and Health Systems (NAPH) also threw its support behind the individual mandate, as well as provisions that encourage innovation, preventative care and community-based collaborations.

Medicaid 'opt-out' provision troubling
However, NAPH raised concerns about the potential limits to the expansion of Medicaid coverage, "which could strand millions of our most disadvantaged people without access to basic healthcare coverage," NAPH President and CEO Bruce Siegel said in an announcement.

The Court limited the federal government's ability to penalize states that do not comply with pieces of the reform legislation by withholding Medicaid funds.

In states that opt out, hospital executives are left wondering what will become of the industry's strides to reduce the cost of healthcare by, for example, keeping non-emergent patients out of the emergency room in favor of less expensive settings, including primary care physician practices.  

"[I]n the 26 states that participated in the federal lawsuit, more than 27 million people have no insurance, and many who would have been eligible for Medicaid in 2014 might no longer have that option. We hope states do the right thing," Siegel said.

Safety-net hospitals, in particular, could be hard-hit in states that opt out. NAPH urged Congress to move beyond "hope alone" for federal policy and instead promote funding for safety-net hospitals.

Financial, efficiency rewards promising
But in general, the affirmation of the ACA should reduce bad debt for the majority of hospitals and health systems. 

"Having 35 million more people insured in some way will moderate the effects of all those people coming to the emergency room who previously had no insurance. Now, at least, there will be some payment for the care they receive," Kenneth Davis, M.D., president and CEO of Mt. Sinai Medical Center in New York City told FierceHealthcare in an interview yesterday. 

"Having more people ensured and having more primary physicians to take care of them will facilitate decreased costs in healthcare [which is something] we're all working on."

Overall, the American Medical Association (AMA) was pleased with the decision, AMA President Jeremy Lazarus said, in part because it will increase efficiency, quality of care and patient-centered care.

Healthcare reform "simplifies administrative burdens, including streamlining insurance claims, so physicians and their staff can spend more time with patients and less time on paperwork," Lazarus said.

For more information:
- here's the AHA statement (.pdf)
- read the NAPH announcement (.pdf)
- check out the FAH media advisory (.pdf)
- here's the AMA statement
- check out the Supreme Court decision (.pdf)

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